Tuberculosis

Question 1

Pathophysiology

Answer 1

Aerobic - most likely at apices of lungs
Slow growing - hence treatment is long
Thick fatty cell wall

Question 2

Who is more prone?

Answer 2

Those from high prevalence countries , HIV positive, immunocompromised

Question 3

Outcome of infection

Answer 3

Swing between
Infection - virulence & number
Susceptibility - age, immunosuppression, nutrition, genetics

Question 4

Aetiology

Answer 4

Bacteria - Mycobacterium tuberculosis, bovis, africanum, leprae

Question 5

Transmission

Answer 5

Airborne - sneezes, yells, coughs

Question 6

Symptoms

Answer 6

Cough
Fevere
Sweats
Weight loss

Question 7

Primary infection

Answer 7

Mycobateria spread to hilar lymph nodes. May cause scars or calcify

Question 8

Symptoms of primary infection

Answer 8

Fever, malaise

Question 9

Primary infection can be

3 things

Answer 9

Progressive
Cleared
Latent

Question 10

Primary infection can lead to

Answer 10

Tuberculous Bronchopneumonia
- enlarged hilar lymph nodes which can compress bronchi, lobar collapse
Milliary Tuberculosis
- spread of bacteria to multiple organs

Question 11

Post primary disease

Answer 11

2 reasons

• bacteria is in dormant stage with low or no replication at all
• balanced state between replication and apoptosis

Question 12

Active pulmonary TB

Answer 12

Primary TB:

• lymphadenopathy
• pleural effusion
• milliary

Question 13

Investigations

Answer 13

Sputum sample
Bronchoscopy with BAL
Endobronchial ultrasound (EBUS) with biopsy
Lumbar puncture in CNS TB
Urine in urogenital TB
Aspirate/biopsy from tissue ( lymph-node, bone, joint, brain, abscess)

Question 14

Treatment

Answer 14

Rifampicin
Isoniazid
Ethambutol
Pyrazinamide

Question 15

How do you need to administer drugs?

Answer 15

2 for 4 months AND 4 for 2 months

Question 16

Which drugs can be administered for 4 months?

Answer 16

Rifampicin, Isoniazid

Question 17

Contraindications for MTB

Answer 17

Do NOT give rifampicin and isoniazid

Question 18

Side effects of drugs

Answer 18

Rifampicin - orange urine, rash, hepatitis, contraceptive methods ineffective
Isoniazid - hepatitis, rash, peripheral neuropathy (give pyridoxine)
Pyrazinamide - hepatitis, rash, gout
Ethambutol - optic neuropathy

Question 19

After how long does the patient feel better?

Answer 19

2 weeks BUT course of treatment needs to be continued for at least 6 months

Question 20

Treatment for Latent TB

Answer 20

Rifampicin and isoniazid for 3 months OR
Rifampicin for 6 months OR
Isoniazid for 6 months

Question 21

Rules for Treatment of TB

Answer 21

Multiple drug therapy essential
Single agent therapy can lead to drug resistant organisms within 14 days
Therapy must continue for 6 months